Provider Demographics
NPI:1770512337
Name:PATRICK G. BRANNAC, MD
Entity Type:Organization
Organization Name:PATRICK G. BRANNAC, MD
Other - Org Name:FRY OPHTHALMOLOGY AND ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:G
Authorized Official - Last Name:BRANNAC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-263-5384
Mailing Address - Street 1:482 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-2622
Mailing Address - Country:US
Mailing Address - Phone:717-263-5384
Mailing Address - Fax:717-263-5725
Practice Address - Street 1:482 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-2622
Practice Address - Country:US
Practice Address - Phone:717-263-5384
Practice Address - Fax:717-263-5725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038495L207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA576935Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER